Today the American Psychiatric Association (APA) releases proposed revisions to the most influential book in psychiatry: the Diagnostic and Statistical Manual of Mental Disorders (DSM). These draft criteria for diagnosing mental disorders are the result of a decade of labor by scores of researchers and clinicians. After gathering comments on the draft criteria and conducting field trials to test them, APA plans to publish a new, fifth edition of the DSM in 2013.
By classifying mental disorders and giving them names, DSM not only influences how doctors diagnose and treat their patients. It also sways how insurance companies decide which conditions to cover, how pharmaceutical companies design clinical trials, and how funding agencies decide what research to fund. Making changes to such a widely used document was bound to be controversial, and it has been. "It's sort of like repairing an airplane while it's still flying," says psychiatrist Steven Hyman, provost of Harvard University and a member of the committee leading DSM-V revisions.
The researchers and clinicians working on DSM-V had several ambitious goals, including using new findings from neuroscience and genetics to shape diagnoses, minimizing vast diagnostic dead zones of abnormal behavior that fall in the cracks of current criteria, and introducing the idea of "dimensions" to reflect varying degrees of symptom severity and the overlap among disorders.
Some critics, including the two psychiatrists who led the previous two major revisions to DSM, have argued that such an ambitious overhaul should not have been attempted until more is known about the biological underpinnings of mental illness.
Duke University psychiatrist Allen Frances, who led the DSM-IV revisions, penned a widely read and debated editorial last year warning that drastic changes to the criteria for diagnosing mental disorders could have unintended consequences, including "false 'epidemics' " of mental illness.
Within the work groups focusing on different types of disorders, members have faced scientific dilemmas and—in some cases—pressure from patient groups. Among a number of new proposals that seem likely to cause a stir are a diagnosis of "pre-psychotic risk syndrome" applicable to young people and a redefinition of autism spectrum disorders that would eliminate Asperger's syndrome, which many consider to be a mild form of autism.
See tomorrow's issue of Science for a more comprehensive overview of the DSM-V draft criteria. In the coming weeks Science will explore several of the new proposals--and researchers' and clinicians' reaction to them--in more detail.